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2 Case Presentation74 y o Caucasian female, with hypertension and critical aortic stenosis.One year prior to presentation, aortic valve replacement had been attempted but was aborted due to severe aortic calcification, so called “porcelain aorta”.Now increasing symptoms of shortness of breath with exertion and chest pain, with recurrent hospital admissions for congestive heart failure.

3 Echocardiogram:LVEF >60% with concentric left ventricular hypertrophy and diastolic dysfunction.Mild mitral regurgitation.Moderate tricuspid regurgitation.Cardiac Catheterization:Normal systolic function. Non-obstructive coronary disease.CT Chest:“Uniform, smooth calcification of the ascending aortaextending from the root to the origin of great vessels, with trivial atherosclerotic calcifications of the descending aorta. The appearance of the ascending aorta is reminiscent of aortic graft.”Extensive aortic valve calcification and moderate mitralvalve calcification.

6 This Case Illustrates ….Calcification can be characterized by theanatomical location.There are more than one type of vascularcalcification.We are unable to efficiently treat vascularVascular calcification may cause clinicalcomplications.

13 Coronary Calcification - EBCTA negative EBCT test is associated with a low risk of a cardiovascular event in the next 2 to 5 years.A positive EBCT confirms the presence of a coronary atherosclerotic plaque.The greater the amount of calcium, the greater the likelihood of occlusive CAD, but there is not a 1-to-1 relationship, and findings may not be site specific.The total amount of calcium correlates best with the total amount of atherosclerotic plaque, although the true "plaque burden" is underestimated